Abstract A large part of morbimortality is caused by lifestyle habits and modifiable risk factors. A promising strategy to promote the change of such factors is the implementation of public health interventions based on behavioral economics, a discipline that combines psychological and economic principles. In the present article, we focus on a type of intervention known as “nudge” (that has been translated into Spanish as empujón or acicate), that changes behaviour without limiting the individual's choice. We analyze the properties that characterize nudges, and several areas in which they have been successfully implemented: vaccination, nutrition, physical activity, smoking cessation and drug prescription. We conclude that behavioural economics and nudges have great potential for their implementation in the public health sphere in Spain.

Abstract Scientific studies showing how regular contact and physical activity in natural environments result in health benefits are increasingly precise and conclusive, and include many aspects related to physical and mental health. Starting from protected areas departments, many initiatives have appeared to incorporate health in the planning and management of these natural spaces, with successful results both for the improvement of the health and well-being of the people and for the conservation of the natural heritage. In recent years, numerous projects have arisen in different autonomous communities and local administrations, which show the potential of this line of collaborative work. It would be desirable to develop a joint strategy between the departments of health and nature conservation in order to enhance the indicated benefits through common projects at different scales.

What is an efficient health intervention in Spain in 2020? Artículos Especiales

Abstract Fifteen years ago, Gaceta Sanitaria published the article entitled “What is an efficient health technology in Spain?” The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process.